Provider Demographics
NPI:1508057381
Name:SACCARO, JOSEPH JAMES (LPN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:SACCARO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DREXELGATE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1608
Mailing Address - Country:US
Mailing Address - Phone:631-241-1747
Mailing Address - Fax:
Practice Address - Street 1:101 DREXELGATE CT
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1608
Practice Address - Country:US
Practice Address - Phone:631-241-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271659164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02867045Medicaid